Consultation | Should I take vitamin B12 supplements? This is what the science says.

ask: I often feel tired and have heard that vitamin B12 can help relieve fatigue and increase energy levels. Should I take supplements?

A: There is no evidence that taking vitamin B12 can relieve fatigue unless you have a vitamin B12 deficiency that causes anemia. Start by asking your doctor to run a simple set of blood tests for vitamin B12 and related biomarkers. Adults over 65 and vegetarians are particularly at risk for vitamin D deficiency.

If you are deficient in vitamins, you should take vitamin supplements.

For others looking for an energy boost, my advice is a medical rule of thumb: Where possible, less is more. Do not take supplements that are not proven to be beneficial. Instead, talk to your doctor about other ways to help boost energy levels, including lifestyle changes or getting tests to rule out underlying medical problems like thyroid disease.

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What are the benefits of vitamin B12?

Vitamin B12 is an essential vitamin that has several important biological functions, including metabolism and the production of healthy blood cells. Here are the areas where we know supplements may be beneficial:

  • Fatigue caused by anemia. Anemia is often thought to be caused by a lack of iron, but low vitamin B12 often causes anemia, which results in abnormally enlarged blood cells.
  • Certain neurological symptoms occur due to deficiency, such as difficulty walking, numbness, or mental problems.

Other areas where many people consider B12 a supplement include muscle pain, arthritis, insomnia, or general weakness (in the absence of anemia), but there is little evidence to support it.

How do I know if my B12 is low?

The most common symptom of low vitamin B12 levels is a vague symptom: fatigue. Cognitive changes, irritability, and even paranoia have also been linked to vitamin B12 deficiency. The same goes for tongue swelling.

Certain ethnic groups are at higher risk for malnutrition and should discuss the need for screening with their physician:

  • Elderly people. About 15% of Americans over the age of 65 suffer from a deficiency related to the loss of stomach acid with aging, which makes it more difficult to absorb vitamin B12 naturally found in food. Older adults are usually able to absorb vitamin B12 from oral supplements or fortified foods without the same problems.
  • Vegan or vegetarian. One small study found that 40% of vegetarians were deficient in vitamin B12.
  • Pernicious anemia or other autoimmune diseases. In pernicious anemia, the body produces antibodies that interfere with the absorption of vitamin B12. These patients should receive lifelong vitamin B12 therapy. Vitamin B12 deficiency is also more common in patients with other autoimmune diseases such as vitiligo or thyroiditis.
  • Gastrointestinal Surgery. People with a history of gastric bypass surgery or other surgeries or diseases that affect specific areas of the intestines (such as celiac disease or Crohn’s disease) may be at higher risk.
  • People who take certain medications for a long time, e.g. Metformin and Acid reducing drugs. These are known to reduce B12 absorption.

How to increase B12 naturally?

Vitamin B12 occurs naturally in animal proteins, including meat, fish, eggs and dairy products. (Fun fact: Clams or beef liver are especially high in it.)

If you eat a completely plant-based diet, you may still get adequate amounts of vitamin B12 from fortified foods, but this is not always the case. Some cereals and many brands of non-dairy milk (such as oat soy milk or silk soy milk) are fortified with B12. Nutritional yeast is a seasoning used in vegan recipes that has a cheesy flavor, which it often does.

The recommended intake of vitamin B12 for adults is 2.4 micrograms. Here are the amounts of vitamin B12 in some common foods:

  • Salmon, 3 ounces: 2.7 mcg
  • Nonfat Plain Greek Yogurt, 3.5 oz: 0.7 mcg
  • 1 large egg: 0.5 mcg
  • Chicken breast, 3.5 ounces: 0.3 mcg

What is the best way to absorb vitamin B12?

Some people prefer vitamin B12 injections, usually given as a muscle injection in the arm at a health care provider’s office or pharmacy. If you are severely deficient, your doctor may recommend taking B12 injections first, but in general, taking high-dose oral vitamin B12 will replenish your system just as well as injectable vitamin B12.

Are there any dangers in taking vitamin B12?

Many of my patients wonder what the harm is in just taking a supplement and seeing what happens. Even high-dose over-the-counter medications, which typically contain 1,000 micrograms, are generally considered safe because our bodies can only absorb a small portion of them. But a 2020 study published in JAMA Network Open found that higher blood levels of vitamin B12 were associated with an increased risk of death from all causes. Other studies have found links between high levels of the vitamin and an increased risk of cardiovascular disease and hip fractures.

What do I want my patients to know?

Unlike many supplements, vitamin B12 is an interesting example of patients and prescribers alike driving unnecessary consumption. A 2019 study published in JAMA Internal Medicine found that most vitamin B12 injections are prescribed inappropriately, i.e., to people without any evidence of vitamin B12 deficiency. Why does this happen? Given B12’s growing popularity, there may be some pressure to respond to patient requests. We can all benefit from becoming better familiar with this research.

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